Provider Demographics
NPI:1750323051
Name:CARTERS PHARMACY L L C
Entity Type:Organization
Organization Name:CARTERS PHARMACY L L C
Other - Org Name:CARTERS PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-496-4530
Mailing Address - Street 1:PO BOX Q
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-1147
Mailing Address - Country:US
Mailing Address - Phone:276-496-4530
Mailing Address - Fax:276-496-4580
Practice Address - Street 1:222 PANTHER LANE
Practice Address - Street 2:
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370
Practice Address - Country:US
Practice Address - Phone:276-496-4530
Practice Address - Fax:276-496-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010040633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105902OtherPK
5555500001Medicare NSC